CPT code 58260 is used for a vaginal hysterectomy procedure for a uterus weighing 250 grams or less, aiding in standardizing medical procedures.
CPT code 58260 is used to describe a surgical procedure known as a vaginal hysterectomy, specifically for the removal of a uterus that weighs 250 grams or less. This code is utilized by healthcare providers to accurately document and bill for this particular type of hysterectomy, which involves the removal of the uterus through the vaginal canal. The specification of the uterus being 250 grams or less is important for coding purposes, as it distinguishes this procedure from other types of hysterectomies that may involve larger uterine sizes or different surgical approaches.
For CPT code 58260, which pertains to a vaginal hysterectomy for a uterus weighing 250 grams or less, the following modifiers may be applicable:
1. Modifier 22 - Increased Procedural Services: This modifier is used when the work required to perform the procedure is substantially greater than typically required. Documentation must support the substantial additional work and the reason for it.
2. Modifier 51 - Multiple Procedures: This modifier is used when multiple procedures are performed during the same surgical session. It indicates that the procedure is one of several performed.
3. Modifier 52 - Reduced Services: This modifier is used when a service or procedure is partially reduced or eliminated at the physician's discretion. Documentation should support the reduction in service.
4. Modifier 53 - Discontinued Procedure: This modifier is used when a procedure is started but discontinued due to extenuating circumstances or those that threaten the well-being of the patient.
5. Modifier 59 - Distinct Procedural Service: This modifier is used to indicate that a procedure or service was distinct or independent from other services performed on the same day. It is used to identify procedures that are not normally reported together but are appropriate under the circumstances.
6. Modifier 76 - Repeat Procedure by Same Physician: This modifier is used when a procedure or service is repeated by the same physician or other qualified healthcare professional subsequent to the original procedure or service.
7. Modifier 77 - Repeat Procedure by Another Physician: This modifier is used when a procedure or service is repeated by another physician or other qualified healthcare professional subsequent to the original procedure or service.
8. Modifier 78 - Unplanned Return to the Operating/Procedure Room by the Same Physician Following Initial Procedure for a Related Procedure During the Postoperative Period: This modifier is used when a patient requires a return to the operating room for a related procedure during the postoperative period.
9. Modifier 79 - Unrelated Procedure or Service by the Same Physician During the Postoperative Period: This modifier is used when an unrelated procedure or service is performed by the same physician during the postoperative period.
10. Modifier 80 - Assistant Surgeon: This modifier is used when an assistant surgeon is required during the procedure.
11. Modifier 81 - Minimum Assistant Surgeon: This modifier is used when a minimum assistant surgeon is required during the procedure.
12. Modifier 82 - Assistant Surgeon (when qualified resident surgeon not available): This modifier is used when an assistant surgeon is required, and a qualified resident surgeon is not available.
13. Modifier AS - Physician Assistant, Nurse Practitioner, or Clinical Nurse Specialist Services for Assistant at Surgery: This modifier is used when these non-physician practitioners assist in surgery.
Each modifier serves a specific purpose and should be used in accordance with the documentation and circumstances surrounding the procedure. Proper use of modifiers ensures accurate billing and reimbursement.
The CPT code 58260 is reimbursed by Medicare, provided it meets the necessary coverage criteria and is deemed medically necessary.
Reimbursement for this code is determined by the Medicare Physician Fee Schedule (MPFS), which outlines the payment rates for services covered under Medicare Part B.
Additionally, the specific reimbursement and coverage details may vary depending on the region, as they are also influenced by the local Medicare Administrative Contractor (MAC).
Each MAC is responsible for processing claims and setting local coverage determinations, which can affect whether and how a particular CPT code is reimbursed.
Therefore, healthcare providers should consult their regional MAC for precise information regarding the reimbursement of CPT code 58260.
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